ARCHIVES OF Arch Iran Med. August 2020;23(8):573-577 IRANIAN doi 10.34172/aim.2020.65 http://www.aimjournal.ir MEDICINE Open History of Medicine Access Caduceus: A Medical Symbol of Deception, or Is There More to That? George Katsaras, MD, MSc, PhDc1*; Vasiliki Chatziravdeli, MD MSc2; Dimitrios Katsaras, MD3; Garyfalia Papavasileiou, MD4 1Paediatric Department, General Hospital of Edessa, Edessa, Greece 22nd Orthopaedic Department, General Hospital of Thessaloniki “Papageorgiou”, Thessaloniki, Greece 3Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK 4Eye Department, St James’s University Hospital, The Leeds Teaching Hospital NHS Trust, Leeds, UK Abstract The serpent is the most popular representative symbol of medicine. The two main figures commonly used are the rod of Asclepius and the caduceus. Much controversy exists in the literature on whether the caduceus is a false symbol for medicine or not. The history of how these depictions came to be ambassadors of the medical science is elusive to many physicians. Scholars suggest that the origin of this false belief dates back to 1902, when the US Army Medical Corps first incorporated the caduceus as its symbol. This current essay is an attempt to discover and interpret how the snake came to be part of the rod of Asclepius and the caduceus, and constitute the symbol of medicine in our days. It is widely accepted that a doctor’s obligation is not only in healing the ill, but the task that is bestowed upon him is more complex. Therefore, one should be considered more of a physician rather than simply a doctor. Keywords: Caduceus, Medical symbol, Rod of Asclepius, Staff of Hermes Cite this article as: Katsaras G, Chatziravdeli V, Katsaras D, Papavasileiou G. Caduceus: a medical symbol of deception, or is there more to that? Arch Iran Med. 2020;23(8):573–577. doi: 10.34172/aim.2020.65. Received: February 11, 2020, Accepted: June 2, 2020, ePublished: August 1, 2020 Introduction 1902 CE, when the US Army Medical Corps started using Throughout human history, the use of symbols has been a it.9–11 The scope of this essay is to review the history of the way to present powerful ideas, whose meaning was often snake and its symbolic use, and to interpret the meaning lost or misinterpreted with the passing of time.1 The of the rod of Asclepius and the staff of Hermes using the snake, which can be found in every culture, was used to information gathered through a “journey” in time. symbolize emotions ranging from fear to adoration.2 The characteristic to shed its skin has been associated with the Ancient Mesopotamia circle of life and the fact that the snake’s own poison can In ancient Babylon, the single serpent depicted the great also be the antivenom made it a metaphorical symbol for earth snake, the primal embodiment of the mother medicine.3 The two most renowned snake symbols used in goddess, and the source of life. Consequently, the snake medicine are the rod of Asclepius and the staff of Hermes symbolized fertility and, with its return in spring, life and or Caduceus. The rod of Asclepius is a staff entwined by a resurrection.12 single snake, while the Caduceus is a short staff entwined by The earliest type of Caduceus is found in ancient two serpents, sometimes surmounted by wings.4 Asclepius Babylonian cylinder seals. It constituted a sexual symbol is the Greek God of medicine, while Hermes from the with one male and one female head attached to a single ancient Greek Pantheon, is the God of commerce, trade body.13 It also appears on the libation vase of King and merchants, as well as the protector of tricksters and Gudea (c. 2100 BCE), who ruled the Babylonian city thieves. Another less popular duty of Hermes was that of Lagash around 3000 BCE. The symbol comprised of of guiding the departed souls to Hades, the underworld two snakes entwined around a rod accompanied by two of Greek mythology.5,6 One could suggest that the Rod gryphons and represented Ningishzida, the “right-hand of Asclepius is related to healing and life, while the staff scepter god”. Ningishzida was the “Herald of the Earth” of Hermes is related to death. A great conflict aroused in and served as a liaison between the ruler and the mother 1928 CE by Hattie W.H. on whether the Caduceus is a goddess Ishtar, goddess of fertility, who was worshiped in false symbol of medicine or not.7,8 The majority of scholars Sumer as early as the Uruk period (4000−3100 BC) and supported that the Caduceus was established in our era as held the Caduceus—Ningishzida in her hand. Similar the symbol of medicine due to a mistake that took place in representations of griffins and two coiled serpents sculpted *Corresponding Author: George Katsaras, MD, MSc, PhDc; End of Egnatia St., 58200 Edessa, Greece. Mobile: 00306939193901; Email: [email protected]. Katsaras et al on a marble amphora have been found in Jiroft, Iran, and While traditionally, the snake is believed to be the Fallen date back to 2500 BCE.1,14 In the Epic of Gilgamesh (c. Angel, according to another Hebrew legend, the snake is 1800 BCE), while reaching the end of his long journeys, none other than the first bride of Adam, Lilith. Lilith is Gilgamesh eventually possessed the secret to eternal life, a known as a demon stealing the infants of man for revenge plant that could make someone young again. But shortly because of a former curse that was bestowed upon her to after taking hold of the plant, it was taken from him by daily suffer the loss of a hundred of her children.27 a serpent while he was having a bath. Following this, the Although in the Book of Genesis the snake depicts snake shed its skin and sneaked into the water.15,16 This cunningness and destruction, in the Book of Numbers, is probably the first reference to the snake’s attribute of we can see the duality of the snake mentioned above. In c. losing their skin and the conviction that snakes could live 1400 BCE, the people of Israel were dying from a plague forever.17 of “fiery” poisonous serpents sent by Jehovah, because they had spoken ill of him. Moses prayed to him and the Lord Ancient Egypt God asked him to make a serpent and put it around a In ancient Egypt, there is evidence of an existing pole. Anyone who had been bitten, if they looked at it relationship between the snake and healing. In a hymn, (the brazen serpent, also known as Nehushtan), would be a workman in the Necropolis of Thebes reveals how saved. And so it happened. The snake was simultaneously the goddess Mertseger presented to him transformed a destructor and a savior.2,6,17,22,26 as a serpent to remedy his disease and make his malady forgotten. Metrseger was a Theban cobra-goddess in Hermes ancient Egyptian religion (1550-1070 BCE) and is According to Frothingham, the ancestor of the Greek depicted as a mountain peak of the western desert. She Hermes was the Babylonian Ningishzida. Hermes was a was charged with guarding and protecting the vast Theban pre-Olympian God and the proto-Hermes was a snake Necropolis and especially the Valley of the Kings.16,18-20 God. He was a dual snake, incorporating both sexes, differentiating him from the Mother Goddess who was Minoan Crete and Ancient Greece represented as the great single Earth Snake. This was the In c. 1600 BCE, the earth’s ability to renew and revive most fertile form of mating in the kingdom of animals. herself was worshipped in the form of Diktynna, the For this reason, the emblem of the God was the Caduceus Minoan ‘‘Great Goddess’’, who was represented with a (kerukeion in Greek, meaning “herald’s wand”), a pair of serpent in each hand, emphasizing her domination over snakes entwined around a wand or scepter. But before it earth’s blossom.1,2,10 became the god’s emblem, the Caduceus had been, in the What is more, the Cretan myth of Glaukos, son of pre-anthropomorphic era, the God himself.12 Minos, correlates the snake with rebirth and resurrection.1 According to the Homeric hymn to Hermes, Zeus’s love According to Hyginus, Glaukos, son of Minos, fell into affair with the nymph Maia resulted in the latter giving a jar full of honey and died, while he was playing ball. birth to Hermes in a cave. Shortly after leaving the cave, Minos made inquiry to Apollo for the boy and then Hermes made the first seven-stringed lyre using sheep Apollo gave them an oracle telling them that the man that intestines, an ox’s hide and reeds attached to a hollow could explain the oracle would be able to restore Glaukos. turtle shell. Hermes was very cunning, and one day he Polyidus, son of Coeranus, was that man. Polyidus stole the cattle of Apollo.28 Apollo, the father of Asclepius, observed an owl putting bees to flight while sitting over warded off disease and healed the sick.7,29 When Apollo the cellar. He interpreted the omen, and brought out the found out, he went to Zeus for a solution. Zeus ordered dead boy from the jar. Afterwards, Minos shut Polyidus Hermes to show Apollo where the cattle were hidden. with the dead boy in a tomb until Polyidus would bring Following this, they reconciled. Hermes took hold of his the boy back to life.